Have peak flow readings that stay above 80 percent of your personal best

Can asthma get worse?

Unfortunately, the answer is yes. The goal of treating asthma is finding the right level of control with the
least amount of medicine so the condition doesn’t worsen. The following are signs of uncontrolled asthma that
your doctor may want to address, to help better control the asthma in your airways.2

Symptoms start to occur more often, are more severe, and/or are bothersome at night, causing you to lose
sleep

Normal activities, such as school or work, are limited because of your asthma

Your peak flow number is low compared to your personal best or varies from day to day

You’ve noticed that your asthma medicines don't seem to work as well anymore

A quick-relief inhaler is needed more than 2 days a week

You’re forced to visit the ER or visit your doctor because of an asthma attack

How does Alvesco work?

Alvesco (ciclesonide) is a synthetic corticosteroid for oral inhalation.3

Corticosteroids are natural anti-inflammatory substances found in the body, which have been shown to reduce
inflammation associated with asthma. Alvesco Inhalation Aerosol may help reduce airway inflammation and has
been shown to help keep asthma symptoms under control.3

It is important to note that Alvesco is not a bronchodilator and should not be used for the relief of sudden
asthma symptoms.3

Alvesco is only indicated for use in adults and adolescents 12 years of age and older.3

How is Alvesco different from other inhaled corticosteroids (ICS)?

Alvesco has a small particle size that enables it to reach deep into the small airways.4,5 This
helps target its anti-inflammatory effect on the small airways.6 Other ICS products with larger
particle sizes tend to stay in the large airways and not reach as many of the small airways.4

Alvesco has been shown to improve lung function and reduce asthma symptoms in clinical trials.3

What are the most common side effects of Alvesco?

The most common side effects with Alvesco Inhalation Aerosol include:3

headache

swelling of nose and throat (nasopharyngitis)

swelling of the sinuses (sinusitis)

throat pain

upper respiratory infection

joint pain (arthralgia)

nasal congestion

pain in arms, legs, and back

What should I tell my healthcare provider before using Alvesco Inhalation Aerosol?

Before you use Alvesco Inhalation Aerosol, tell your healthcare provider if you:3

have or have had eye problems such as increased ocular pressure, glaucoma, or cataracts.

have any infections including tuberculosis or ocular herpes simplex.

have not had or been vaccinated for chicken pox or measles.

are pregnant or plan to become pregnant. It is not known if Alvesco Inhalation Aerosol will harm your
unborn baby. Talk to your healthcare provider if you are pregnant or plan to become pregnant.

are breastfeeding or plan to breastfeed. It is not known if Alvesco Inhalation Aerosol passes into your
breast milk. Talk to your healthcare provider about the best way to feed your baby if you are using Alvesco
Inhalation Aerosol.

Tell your healthcare provider about all the medicines you take, including prescription and
non-prescription medicines, vitamins and herbal supplements.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get
a new medicine.

References:

National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI). How is Asthma
Treated and Controlled? https://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment. Accessed Oct
17, 2017.

National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI).What are the Signs
and Symptoms of Asthma? https://www.nhlbi.nih.gov/health/health-topics/topics/asthma/signs. Accessed Oct 17,
2017.

IMPORTANT SAFETY INFORMATIONThese highlights do not include all the information needed to use
ALVESCO safely and effectively. See Full
Prescribing Information for ALVESCO.

INDICATION for ALVESCO (ciclesonide) INHALATION AEROSOLALVESCO is for the long-term
treatment of asthma as preventative therapy in adults and adolescents 12 years of age and older. ALVESCO is
NOT indicated for the relief of acute bronchospasm. ALVESCO is NOT indicated for children under 12 years of
age.

IMPORTANT SAFETY INFORMATION FOR ALVESCOALVESCO is NOT a rescue inhaler and should not
be used for relief of sudden symptoms of shortness of breath during an asthma attack. Use a fast-acting rescue
medicine (such as a levalbuterol or albuterol inhaler) to relieve sudden symptoms if you have an asthma
attack. You should contact your healthcare professional if an asthma attack does not respond to your rescue
medicine or you need to use your rescue medicine more often than usual.

You should not use ALVESCO if you are allergic to ciclesonide or any of the ingredients in ALVESCO. Rare
cases of severe allergic reactions, including swelling of the lips, tongue and throat, have been reported.

Yeast infections of the mouth and throat (thrush) have occurred in some ALVESCO patients. Rinse your mouth
after you inhale each dose of ALVESCO. If you develop a yeast infection, it should be treated by a healthcare
professional.

Patients taking ALVESCO are at a possible increased risk of infection due to a weakened immune system that
may occur when taking a steroid medicine. Tell your healthcare professional if you have had tuberculosis (TB)
or any other infections before or while using ALVESCO, or if you are exposed to chickenpox or measles.

If you took an oral (by mouth) steroid previously and are having the dose decreased, or you have been
switched to ALVESCO from an oral steroid, tell your healthcare professional right away about any symptoms such
as feeling tired or exhausted, weakness, nausea, vomiting, or symptoms of low blood pressure (such as
dizziness or faintness). These may be symptoms of a potentially life-threatening condition in which your body
does not produce enough natural steroids.

Using inhaled steroid medicines for a long time may put you at greater risk for decreased bone mass (which
can cause bones to become weaker). Inhaled corticosteroids including ALVESCO may cause slowed growth in
children and adolescents. Your healthcare professional should monitor your bone health and the growth of
children and adolescents taking ALVESCO.

Glaucoma, increased pressure in the eye, and cataracts have been seen in patients who received inhaled
steroid medications, including ALVESCO. Your healthcare professional should monitor you especially if you have
a change in vision or have a history of increased pressure in the eye, glaucoma, and/or cataracts.

As with other inhaled asthma medicines, bronchospasm (a sudden squeezing of the airways) can occur, with
wheezing, right after you inhale your dose of ALVESCO. If this happens, stop using ALVESCO and use a rescue
medicine right away, such as levalbuterol or albuterol. You should also inform your healthcare professional
right away so that your asthma medicine can be re-evaluated.

It is important to take ALVESCO regularly, as prescribed. Do not stop treatment even if you are feeling
better, unless told to do so by your healthcare professional. You should contact your healthcare professional
if your symptoms do not improve after 4 weeks, or if your condition worsens at any time during treatment. DO
NOT inhale more doses or use your ALVESCO inhaler more often than you have been directed.

What are some of the possible side effects of ALVESCO?The most common side effects
with ALVESCO include headache, pain or irritation of the nose and throat, sinus infection, upper respiratory
infection (such as the common cold), joint pain, stuffy nose, leg or arm pain, and back pain.

To report SUSPECTED ADVERSE REACTIONS, contact Covis Pharma at 1-866-488-4423 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.